Nightmares are dreams that cause you to awaken with intense feelings of anxiety, fear or dread. The vivid content of a nightmare tends to be easily remembered. An episode of sleep terrors also involves waking with a feeling of intense fear. It often occurs along with a cry or piercing scream. During an episode of sleep terrors you may be unresponsive and appear to be confused. Both nightmares and sleep terrors are common in children and tend to be a normal part of childhood.

KEY POINTS:

  • Nightmares and sleep terrors begin to appear as a young child’s brain and body continue to develop.
  • Nightmares may begin to occur in children as young as 2.5 years of age.
  • Nightmares occur in 60% to 75% of children.
  • Sleep terrors are less common than nightmares.
  • Frequent nightmares also are uncommon, occurring in only 1% to 5% of young children.
  • These sleep problems tend to go away without treatment as a child gets older.

Is My Child At Risk:

Nightmares usually start between 3 and 6 years of age. The proportion of children reporting nightmares reaches a peak between 6 and 10 years of age. Frequent nightmares can result from exposure to severe stress or trauma. Sleep terrors usually emerge in children between 4 and 12 years of age and tend to go away in the teen years.

GENERAL OVERVIEW

Nightmares can be extremely disturbing to a child. They involve dreams that seem real. The action in these dreams tends to include danger or threat. Nightmares occur more often in the second half of the night during the stage of rapid eye movement (REM) sleep. A child responds to a nightmare by waking up suddenly. He or she quickly becomes alert and usually responds by crying. Nightmares cause a child to seek comfort from a parent or caregiver. Although a child often is able to recall clear details of a nightmare, a young child may have a hard time describing it.

Sleep terrors, which are also called “night terrors,” tend to occur in the frst half of the night during the stage of deep, slow wave sleep. They are much less disturbing to nchildren than nightmares. A child often has no memory of the event. However, sleep terrors can be distressing for a parent or caregiver. The child sits up in bed and makes a loud, piercing scream or cry with a look of intense fear on his or her face. Other physical signs may include sweating, rapid breathing and a rapid heart rate. The child tends to be unresponsive. If you wake the child, he or she may seem confused and disoriented.

TREATMENTS:

A child may be afraid to go back to sleep after a nightmare. Therefore, it is important to comfort and reassure your child. Discuss nightmares openly
with your child during the day. Assure your child that it is normal for children and even adults to have nightmares. Avoid exposing your child to frightening images, shows and movies. Talk to your child’s doctor if frequent nightmares disturb your child. Cognitive behavioral therapy techniques, such as imagery rehearsal therapy, may help prevent nightmares in children. Your child’s doctor may prescribe a low-dose medication to help reduce nightmares related to a traumatic event.

You may be unable to comfort a child who is having a sleep terror. Most episodes are brief, so you should try to avoid waking the child. If left undisturbed, he or she is likely to return to sleep quickly with no memory of the event. Frequent sleep terrors may occur at the

same time every night. In this case, briefly wake your child a few minutes before the sleep terrors tend to occur. Talk to your child’s doctor if sleep terrors are frequent and disturbing.

TIPS:

  • Establish a regular bedtime and implement a relaxing bedtime routine for your child.
  • Children 3 to 5 years of age should sleep 10 to 13 hours on a regular basis, including naps.
  • Children 6 to 12 years of age should sleep 9 to 12 hours nightly.
  • Avoid exposing your child to frightening images.
  • Create a calm, soothing sleep environment in your child’s bedroom.

Next Steps:

  • Talk to your child’s doctor about any ongoing sleep problems.
  • The sleep doctor may schedule your child for a sleep study if your child has symptoms of a sleep disorder.
  • The doctor will help fnd and treat any underlying causes of your child’s sleep problem.
  • Your child’s doctor may refer you to a sleep doctor for help.

ACKNOWLEDGEMENT: CONTENT DEVELOPED BY THE AMERICAN ACADEMY OF SLEEP MEDICINE